NONARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY AFTER INTRAVITREAL AFLIBERCEPT FOR AGE-RELATED MACULAR DEGENERATION

Abstract

Purpose: To report a case of non-arteritic anterior ischemic optic neuropathy (NAION) after intravitreal injection in a patient with a history of fellow-eye NAION. Methods: Observational case report. Results: An 82-year-old woman with a history of fellow eye NAION developed an inferior visual field defect 1 day after an intravitreal aflibercept injection for neovascular age-related macular degeneration (AMD). She was found to have optic disc edema and an inferior altitudinal defect, consistent with NAION. The mechanism may have involved compromised perfusion to the optic nerve head related to elevated intraocular pressure or vasoconstriction due to anti-vascular endothelial growth factor activity. Conclusions: NAION is a rare complication of intravitreal injection and may be related to post-injection elevation in IOP. Monitoring of IOP post-injection with low-threshold for pre-injection aqueous suppression or post-injection anterior chamber paracentesis for persistently elevated IOP is recommended in patients with a history of NAION.